Provider Demographics
NPI:1831520253
Name:ZEIDAN, MOHAMAD
Entity type:Individual
Prefix:
First Name:MOHAMAD
Middle Name:
Last Name:ZEIDAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2837 SUNLAKE LOOP APT 311
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746
Mailing Address - Country:UM
Mailing Address - Phone:407-256-2854
Mailing Address - Fax:
Practice Address - Street 1:4106 W LAKE MARY BLVD STE 130
Practice Address - Street 2:
Practice Address - City:LAKE MARY
Practice Address - State:FL
Practice Address - Zip Code:32746-3383
Practice Address - Country:US
Practice Address - Phone:407-878-7615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-11
Last Update Date:2013-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS51417183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist